Evolution of an Astrocytic Hamartoma of the Optic Nerve Head in a Patient with Retinitis Pigmentosa – Photographic Documentation over 2 Years of Follow-Up

Aim: To report photographically the evolution of an astrocytic hamartoma of the left optic nerve head over a 2-year follow-up in a patient with retinitis pigmentosa. Methods: A 14-year-old boy was seen in the medical retina clinic with a 3-year history of night blindness. Best corrected visual acuity was 6/18 in both eyes. Colour vision was normal in both eyes and confrontation fields showed peripheral constriction. Fundus examination revealed bone spicule pigmentary changes at the retinal mid periphery typical of retinitis pigmentosa and superficial globules at the margins of both optic nerve heads. Electrodiagnostic tests confirmed moderately severe rod cone dystrophy with macular involvement bilaterally. Results: Two years later, the ocular examination was unchanged except for the appearance of the optic nerve head lesion in the left eye. There was an increase in the size of the lesion which was diagnosed as an astrocytic hamartoma. Further investigations were recommended to exclude neurofibromatosis and tuberous sclerosis. Conclusion: Astrocytic hamartomas of the optic nerve head and optic nerve head drusen have both been described in patients with retinitis pigmentosa. They can be a diagnostic dilemma although drusen are more common (10%). To differentiate these two entities it is very important to document any growth during the follow-up period which is suggestive of astrocytic hamartoma rather than optic disc drusen

Keratoconjunctivitis and Periorbital Edema due to Ecballium elaterium

Purpose: To report on a case of keratoconjunctivitis with periorbital edema after accidental exposure to undiluted juice of Ecballium elaterium fruit during the ripening season of this plant. Methods: Case report. Results: Keratoconjunctivitis with Descemet’s membrane folds and superficial upper corneal well-defined edematous areas were noted after an Ecballium elaterium fruit burst and its juice splashed into the patient’s left eye. Prompt administration of antibiotic and steroid eye drops along with per os antihistamine therapy, resulted in quick regression of symptoms. Conclusions: This report demonstrates the toxic effects of this herb to the eye and also that prompt therapy is effective

Ulnar Neuropathy as a Complication of Retinal Detachment Surgery and Face-Down Positioning

Purpose: To report a case of bilateral ulnar neuropathy as an extraocular complication following retinal detachment surgery and face-down positioning. Methods: Case report. Results: Bilateral hypoesthesia and numbness of the 4th and 5th finger started 2 weeks after vitrectomy for retinal detachment and face-down positioning. Due to progressive symptoms 6 months later, unilateral ulnar nerve decompression at the elbow was performed. Conclusions: This case report demonstrates that strict face-down positioning bears the risk of ulnar neuropathy

Intravitreal Aflibercept in Recalcitrant Radiation Maculopathy due to External Beam Radiotherapy for Nasopharyngeal Cancer: A First Case Report

Purpose: To present the safety and efficacy of intravitreal aflibercept (Eylea) in a patient with radiation maculopathy secondary to external beam radiotherapy for nasopharyngeal cancer unresponsive to other therapeutic options. Methods: A 73-year-old female presented with decreased visual acuity in both eyes 18 months after completing 47 external beam cycles of radiation for nasopharyngeal cancer. On presentation, her best corrected visual acuity was 6/60 in the right eye and counting fingers from 1 meter in the left eye. She received 5 bevacizumab injections in the right eye and 7 bevacizumab injections in the left eye over the last year without any improvement. A treatment with intravitreal injections of aflibercept was recommended in both eyes. Results: The patient received 3 intravitreal aflibercept injections (2 mg/0.05 mL) in each eye every 4 weeks. The visual acuity improved from 6/60 to 6/12 in the right eye and from counting fingers to 6/36 in the left eye. Biomicroscopy showed less exudates, hemorrhages, and microaneurysms. Optical coherence tomography revealed reduced central retinal thickness in both eyes after 1–3 intravitreal aflibercept injections. Conclusion: Intravitreal aflibercept should be regarded a safe and effective treatment in patients with recalcitrant macular edema due to radiation maculopathy

Clinical , anatomical and electrophysiological assessments of the central retina following intravitreal bevacizumab for macular edema secondary to retinal vein occlusion

Purpose: To evaluate the long-term visual, anatomical and electrophysiological outcomes of repeated intravitreal injections of bevacizumab for macular edema due to retinal vein occlusion and investigate any possible toxic effects on the central fovea.Methods: Prospective, non comparative, interventional case series.Thirty three eyes of 33 patients with macular edema secondary to retinal vein occlusion were treated with1.25mg/ 0.05ml intravitreal bevacizumab. Nine patients had non ischemic central retinal vein occlusion (CRVO) and twenty four patients had branch retinal vein occlusion (BRVO). The main outcome measures were best-corrected visual acuity, central retinal thickness (CRT) and multifocal electroretinography (mfERG) responses changes at baseline, one month after the third injection and at the end of the two year long follow up period.Results: Patients with CRVO had mean best-corrected Snellen visual acuity of 0.10 at baseline, which improved significantly to 0.31 after two years (P=0. 028).The mean CRT at presentation was 756.28 μm and reduced significantly to 439.14 μm after two years (P=0.05). Patients with BRVO had mean best-corrected Snellen visual acuity of 0.19 at baseline, which improved significantly to 0.40 after two years (P< 0.001). The mean CRT at presentation was 681.04 μm and reduced significantly to 369.81 μm after two years (P<0.001). Mean multifocal electroretinography responses within central 10 degrees (ring1, ring2) showed statistically significant differences on P1 parameters in terms of response density and implicit time after two years in both CRVO and BRVO patients. Conclusions: Repeated intravitreal bevacizumab injections for macular edema due to either CRVO or BRVO resulted in long term improvement of visual acuity, a reduction in central retinal thickness and statistically significant changes in the multifocal electroretinography responses with non demonstrable toxic effects on the central fovea.Σκοπός:Η εκτίμηση της μακροχρόνιας αποτελεσματικότητας των επαναλαμβάνομενων ενδουαλοειδικών ενέσεων bevacizumab για τη θεραπεία του οιδήματος της ωχράς κηλίδας που οφείλεται σε απόφραξη φλέβας αμφιβληστροειδούς και η διερεύνηση πιθανής τοξικής επίδρασης τους στο κεντρικό βοθρίοΜέθοδος:Τριάντα τρία μάτια 33 ασθενών με οίδημα ωχράς κηλίδας οφειλόμενο σε απόφραξη φλέβας αμφιβληστροειδούς έλαβαν θεραπεία με ενδουαλοειδικές ενέσεις 1.25mg/ 0.05ml bevacizumab. Εννέα ασθενείς είχαν μη ισχαιμική απόφραξη κεντρικής φλέβας αμφιβληστροειδούς και είκοσι τέσσερις ασθενείς είχαν απόφραξη κλάδου φλέβας αμφιβληστροειδούς.Οι παράμετροι που μελετήθηκαν ήτανε η καλύτερη διορθωμένη οπτική οξύτητα,το κεντρικό πάχος του αμφιβληστροειδούς και η ηλεκτροφυσιολογική δραστηριότητα του κεντρικού τμήματος της ωχράς κηλίδας όπως εκτιμάται με το πολυεστιακό ηλεκτροαμφιβληστροειδογράφημα κατά την έναρξη της μελέτης, ένα μήνα μετά την τρίτη ένεση και στο τέλος του χρόνου παρακολούθησης των δύο ετών.Αποτελέσματα:Οι ασθενείς με απόφραξη κεντρικής φλέβας αμφιβλητροειδούς είχαν κατά μέσο όρο καλύτερη διορθωμένη οπτική οξύτητα 0.10 κατά την έναρξη της παρακολούθησης και βελτιώθηκε σε στατιστικά σημαντικό βαθμό στο 0.31 μετά από δύο χρόνια.( P=0. 028). Το μέσο κεντρικό πάχος του αμφιβληστροειδούς κατά την έναρξη της θεραπείας ήτανε 756.28 μm το οποίο μειώθηκε σημαντικά στο 439.14 μm μετά από δύο χρόνια(P=0.05). Οι ασθενείς με απόφραξη κλάδου φλέβας αμφιβληστροειδούς είχαν μέση διορθωμένη οπτική οξύτητα 0.19 κατά την έναρξη της παρακολούθησης, η οποία βελτιώθηκε σε στατιστικά σημαντικό βαθμό στο 0.40 μετά από δύο χρόνια(P< 0.001). Το μέσο κεντρικό πάχος του αμφιβληστροειδούς κατά την έναρξη της παρακολούθησης ήτανε 681.04 μm και μειώθηκε σημαντικά σε 369.81 μm μετά από δύο χρόνια (P<0.001). Η μέση τιμή των απαντήσεων που κατέγραψε το πολυεστιακό ηλεκτροαμφιβληστροειδογράφημα στις κεντρικές δέκα μοίρες ( περιοχή 1, περιοχή 2 ) παρουσίασε στατιστικά σημαντική διαφορά του κύματος P1 όσον αφορά το ύψος των δυναμικών και το χρόνο εμφάνισης του μετά από δύο χρόνια και στις δύο ομάδες ασθενών.Συμπέρασμα:Οι επαναλαμβανόμενες ενδουαλοειδικές ενέσεις bevacizumab ως θεραπεία για το οίδημα της ωχράς κηλίδας που οφείλεται σε απόφραξη κεντρικής ή κλαδικής φλέβας αμφιβληστροειδούς είχαν σαν αποτέλεσμα τη βελτίωση της οπτικής οξύτητας, τη μείωση του κεντρικού πάχους του αμφιβληστροειδούς και αλλαγές σε στατιστικά σημαντικό βαθμό όσον αφορά τις απαντήσεις του πολυεστιακού ηλεκτροαμφιβληστροειδογραφήματος χωρίς να καταγράφεται τοξική επίδραση στην ωχρά κηλίδα

Central Serous Chorioretinopathy Associated with Desmopressin Nasal Spray: Causality or Unfortunate Association

Purpose: To describe the possible association between central serous chorioretinopathy (CSCR) and desmopressin use. Methods: The case histories of 2 middle-aged men with CSCR using desmopressin nasal spray were studied. Results: The diagnosis of CSCR was made on the basis of clinical features and ancillary testing (fluorescein angiography and optical coherence tomography). Both patients were using desmopressin nasal spray for polyuria when they developed the first ocular symptoms. Both of them also had an independent risk factor for developing CSCR. Conclusion: We suggest that desmopressin-induced hypercortisolism might implicate the development of CSCR in some patients. A larger study on patients using desmopressin nasal spray would be beneficial to confirm the possible association between this form of therapy and the development of CSCR

Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up

Eleni Loukianou, Dimitrios Brouzas, Eleni Georgopoulou, Chrysanthi Koutsandrea, Michael ApostolopoulosEye Department, University of Athens, Athens, GreecePurpose: To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin&amp;reg;) as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma.Case: A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA) 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA) was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin&amp;reg;) was recommended. The injections were performed on a six-weekly basis.Results: The central retinal thickness prior to the treatment was 458 &amp;mu;m. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 &amp;mu;m. After the third injection, the central retinal thickness was 359 &amp;mu;m and 18 months after presentation, it reduced to 334 &amp;mu;m. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period.Conclusion: Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.Keywords: bevacizumab (Avastin&amp;reg;), choroidal melanoma, macular edema, radiation retinopath

Complete Resolution of a Giant Pigment Epithelial Detachment Secondary to Exudative Age-Related Macular Degeneration after a Single Intravitreal Ranibizumab (Lucentis) Injection: Results Documented by Optical Coherence Tomography

Aim:To describe a patient with a giant pigment epithelial detachment (PED) secondary to exudative age-related macular degeneration (ARMD) successfully treated with a single intravitreal ranibizumab (Lucentis) injection (0.5 mg/0.05 ml).Methods:An 89-year-old woman presented with a six-day history of reduced vision and distortion in the left eye. Best-corrected visual acuity in that eye was 6/15. Fundoscopy revealed a giant PED and exudates temporally to the fovea. Optical coherence tomography showed a PED associated with subretinal and intraretinal fluid. Fluorescein angiography confirmed the diagnosis of an occult choroidal neovascularization. Treatment with intravitreal injections of ranibizumab (Lucentis) was recommended, although the increased risk of retinal pigment epithelium (RPE) rip was mentioned. Results:Four weeks after the first intravitreal Lucentis injection, the visual acuity in the left eye improved to 6/7.5, with a significant improvement of the distortion and a complete anatomical resolution of the PED confirmed by optical coherence tomography. Conclusion:Giant PED secondary to exudative ARMD can be successfully treated with intravitreal ranibizumab, despite the increased risk of RPE rip. To our knowledge, this is the first case presenting with complete resolution of PED after a single ranibizumab injection

Pseudotumor Cerebri in a Child with Idiopathic Growth Hormone Insufficiency Two Months after Initiation of Recombinant Human Growth Hormone Treatment

Purpose. To report a rare case of pseudotumor cerebri (PTC) in a child two months after receiving treatment with recombinant human growth hormone (rhGH) and to emphasize the need of close collaboration between ophthalmologists and pediatric endocrinologists in monitoring children receiving rhGH. Methods. A 12-year-old boy with congenital hypothyroidism started treatment with rhGH on a dose of 1,5 mg/daily IM (4.5 IU daily). Eight weeks later, he was complaining of severe headache without any other accompanying symptoms. The child was further investigated with computed tomography scan and lumbar puncture. Results. Computed tomography scan showed normal ventricular size and lumbar puncture revealed an elevated opening pressure of 360 mm H2O. RhGH was discontinued and acetazolamide 250 mg per os twice daily was initiated. Eight weeks later, the papilledema was resolved. Conclusions. There appears to be a causal relationship between the initiation of treatment with rhGH and the development of PTC. All children receiving rhGH should have a complete ophthalmological examination if they report headache or visual disturbances shortly after the treatment. Discontinuation of rhGH and initiation of treatment with acetazolamide may be needed and regular follow-up examinations by an ophthalmologist should be recommended